Intentional Interviewing and Counseling: Facilitating Client Development in a Multicultural Society 7th Edition Allen E. Ivey University of Massachusetts Mary Bradford Ivey Microtraining Associates Carlos P. Zalaquett University of South Florida Copyright © 2009 Chapter 8 Integrating Listening Skills: How to Conduct a WellFormed Interview The secret of joy in work is contained in one word - excellence. To know how to do something well is to enjoy it. Pearl S. Buck Chapter goals ▲ The goal of this chapter is to move you toward intentional competence. ▲ You will be able to engage in a full well-formed interview using only listening skills. ▲ The relationship—story and strengths—goals—restory— action model will enable you to complete a full session and serve as a foundation for effective listening and structuring the interview. The model can be used with multiple theories of counseling. Competency objectives ▲ Understand the basic listening sequence (BLS), which integrates the listening skills learned so far, and see how it is used in multiple settings where clear communication is vital. ▲ Identify the specific dimensions of empathy and understand how the listening skills are vital for empathetic interviews. ▲ Gain awareness of the impact of interviewing, counseling, and psychotherapy on the brain, particularly as it relates to empathic understanding. ▲ Conduct a complete interview using only the listening skills within the relationship— story and strengths—goals — restory—action model. Activity ▲ What is your present story? ▲ How are you living your life in one of the following areas: leisure/ play, physical activities, relationships, spiritual matters? ▲ Name at least two specific strengths that you observe in your story or life that might enable you to improve on where you are now. ▲ Identify a concrete and measurable goal for doing something better? ▲ Now it is time to restory. Take your present story and your goal and note the difference between where your story is and where you would like it to be. ▲ Start the restorying process by imagining an ideal solution in which the present story is transformed. ▲ Do your two strengths help in this process? Imagine how actually meeting that smaller goal would result in a new paragraph or two in the larger story, perhaps even serving as a wedge for greater change later on. ▲ Can you live into your new story? INTRODUCTION: A REVIEW OF CULTURAL INTENTIONALITY AND INTENTIONAL COMPETENCE ▲ All interviewing contains multicultural dimensions. ▲ Same skills may have different effects on people with varying individual and cultural backgrounds. Multicultural differences Individual differences ▲ What “works” as expected one time may not the next. ▲ Intentionally competent counselors are flexible and have the ability to move and change in the moment with constantly shifting client needs. The Basic Listening Sequence: Its Real Promise to Make a Difference ▲ Observations of interviews revealed a common thread of skill usage: Relationship established first, Session begin with an open question, Closed questions for diagnosis and clarification, Paraphrases are used to check out the content of client’s story, Reflection of feeling (usually brief in the early stages) examines key emotions. Summary of the concern expressed by the client completes the interview. Encouragers are used throughout to enrich it and evoke details. The Basic Listening Sequence: Its Real Promise to Make a Difference Three-Part Goal of BLS Elicit: ▲ An overall summary of the issue. ▲ The key facts of the situation. ▲ The central emotions and feelings. The Basic Listening Sequence: Its Real Promise to Make a Difference Three-part goal of the basic listening sequence (BLS): ▲ The key facts and thoughts around the situation. These are obtained through “what” questions, encouragers, and paraphrases. This includes client thoughts about what happened. ▲ The central emotions and feelings. You elicit emotions through questions (such as “Could you share your feelings about that issue?” “How does that feel?”), reflection of feeling, and encouragers that focus on emotional words. ▲ An overall summary of the issue. At the close of a section of the interview, you may want to summarize the client’s main facts and feelings. Sometimes it is useful to start a session with a summary. Basic Listening Sequence (BLS) When you use the BLS you can predict how clients may respond. Basic Listening Sequence: Select and practice all elements of the basic listening sequence, open and closed questions, encouraging, paraphrasing, reflection of feeling, and summarization. These are supplemented by attending behavior and client observation skills. Predicted Result: Clients discuss their stories, problems, or concerns, including the key facts, thoughts, feelings, and behaviors. Clients feel that their stories have been heard. Basic Listening Sequence (BLS) BLS Skills Usage Open Questions begin the session Closed Questions diagnosis and clarification Encouragers evoke details throughout Paraphrase reflects essence of client talk Reflection of Feeling examines key emotions Summary reviews and closes interviews Attending/observation skills underlie the process. Basic Listening Sequence (BLS) ▲ BLS skills need not be used in a specific order. ▲ Adapt the skills to meet client needs. ▲ Observe and flex use of skills to support the client. ▲ Use client observation skills to note client reactions and effectively support him or her. ▲ Includes skills of questioning, encouraging, paraphrasing, reflection of feeling, and summarizing. ▲ Used in many settings to define problems and outcomes. ▲ Is critical in identifying client positive assets and strengths. Positive Asset Search ▲ Counseling, interviewing, and psychotherapy can be difficult experiences for some clients. ▲ They come to resolve problems but session become a depressing litany of failures and fears. ▲ People grow from their strengths. Positive Asset Search ▲ Take a wellness approach and use the BLS to draw out the client’s strengths and resources. ▲ The effective interviewer seeks constantly to find positive wellness strengths--things that client does right. ▲ Emphasis of positive assets gives client a sense of personal power in the interview. Positive Asset Search Definition ▲The positive asset search is a psychoeducational intervention that emphasizes human development rather than remediation of problems. ▲You want to draw out stories of strength and wellness that clients can draw on to work with their challenges. INSTRUCTIONAL READING 1: EMPATHY AND MICROSKILLS ▲Carl Rogers (1957, 1961) emphasized empathy. Listen carefully, enter the world of the client, and communicate that you understand the client’s world as the client sees and experiences it. But, do not become the client—you understand, but also remain separate from the client. INSTRUCTIONAL READING 1: EMPATHY AND MICROSKILLS ▲ Empathy… is experiencing the world as if you are the client, but remaining separate. is communicating to the client that you understand. is key in all human communication. is central to the relationship and the “working alliance.” forms part of that 30% of common factors that make for successful interviewing, counseling, and psychotherapy. Empathy When you provide an empathic response, you can predict how clients may respond. Note below another description of empathy and the predictions that you can make. Empathic Response: Experiencing the client’s world as if you were the client. Understand his or her key issues and feed them back to clarify experience. It requires attending skills and using the important key words of the client, but distilling and shortening the main ideas. In additive empathy the interviewer may add meaning and feelings beyond those originally expressed by the client. If done ineffectively, it may subtract from the client’s experience. Predicted Result: Clients feel understood and engage in more depth in exploring of their issues. Empathy is best assessed by the client’s reaction to a statement. Three types of empathic understanding ▲ Basic empathy: interviewer responses are interchangeable with the client. ▲ Additive empathy: interviewer responses add to or link to what the client has said ▲ Subtractive empathy: interviewer gives back less or distorts what the client has said. I. Basic empathy ▲ Interviewer responses are very similar to the client. ▲ Interviewer accurately feeds back to the client. ▲ Accurate use of BLS demonstrates basic empathy. II. Additive empathy ▲ Interviewer response may add to the client response. ▲ Addition may link to earlier client response or provide bridge to new perspective. ▲ Skilled use of listening and influencing enables interviewer to become additive. III. Subtractive empathy ▲ Interviewer response is distorted, inaccurate, or less than the client’s response. ▲ When this occurs, listening and influencing skills are used inappropriately. You can rate the quality and helpfulness of your interventions. ▲ A 5-point scale for rating level of empathic response. Level 1 Subtractive 2 3 Interchangeable (Basic) 4 5 Additive Positive regard ▲ Selectively attending to positive aspects and responding to the client as a worthy human being. Closely related to the search for strengths and positive assets. More challenging, it also asks you to look at all clients positively, regardless of who they are and what they have done. You don’t have to agree, just regard humanity as positive. Respect and Warmth ▲ Most easily rated from kinesthetic and nonverbal perspective. ▲ Demonstrate by open posture, smiling, and vocal qualities. ▲ Be congruent with your body language. Concreteness ▲ Seek specific feelings, thoughts, descriptions, and examples of action. ▲ “Could you give me an example of . . .?” ▲ Interviewer leads need to be very specific. Directive Feedback Interpretation Immediacy—Here and Now ▲ Be in the moment with the client. ▲ Most powerful response is often in the present tense. ▲ Change of tense may speed up or slow down the interview. ▲ Shifting to new tense from client’s constant tense may be useful. Nonjudgmental Attitude ▲ Suspend your own opinions and attitudes. ▲ Assume a value of neutrality. ▲ Expressed through vocal qualities, body language, and neutral statements. ▲ There are no absolutes on how to use non-judgmental attitude. ▲ Interviewers may be challenged by dishonest, violent, sexist and/or racist clients. Authenticity or Congruence ▲ Are you personally real? ▲ Authenticity and congruence are the reverse of discrepancies and mixed messages. ▲ Counselor remains congruent and genuine. ▲ Counselor flexibility responding to the client demonstrates authenticity. INSTRUCTIONAL READING 2: THE FIVE STAGES/DIMENSIONS OF THE WELL-FORMED INTERVIEW Relationship—Story and Strengths— Goals—Restory—Action Five-Stage Interview When you use the five stage interview structure, you can predict how clients may respond. The Five-Stage Interview Structure: Relationship— Story and Strengths—Goals— Restory—Action Predicted Result: The client will establish a positive relationship with the interviewer, will tell story, will set realistic goals, develop a new story or way of viewing issues, and transfer new learning to daily life. THE FIVE STAGES/DIMENSIONS OF THE WELL-FORMED INTERVIEW 1. Relationship—Initiating the session. Rapport, trust building, and structuring 2. Story and Strengths—Gathering data. Drawing out stories, concerns, problems, or issues 3. Goals—Mutual goal setting. What does the client want to happen? 4. Restory—Working. Exploring alternatives, confronting client incongruities and conflict, restorying 5. Action—Terminating. Generalizing and acting on new stories Five-Stage Interview Circle of Interviewing Relationship Initiating the Session Rapport & structuring Action Terminating. Generalizing and acting on new stories Positive Asset Search & Wellness Restory Working Exploring alternatives Story and Strengths Gathering Data Drawing out stories/issues Goals Set Mutual Goals What does the client want to happen? Five Stage / Dimension Interview Structure ▲ Ensures purpose and direction. ▲ Helps define specific outcomes. ▲ Dimensions denote uniqueness of each client and the holistic nature of the interview. ▲ Fits many theories; different interview theories give different emphasis to each of the stages. ▲ The ability to conduct a whole interview with only listening skills may be considered a prime competency of intentional interviewing. Stage 1. Relationship Initiating the Session. Rapport, Trust building, and Structuring (“Hello”) ▲ Rapport ▲ Trust building ▲ Structuring Stage 2. Story and Strengths Gathering Data. Drawing Out Stories (“What is your concern?” “What are your strengths and resources?”) ▲ Listen to the client’s story -- find out why the client is present. ▲ The positive asset search is included in this part of the interview. Clients grow from strength. ▲ The word problem may not be a good choice for some clients. ▲ Different cultures may prefer issues, stories, or concerns and to discuss them at a later stage in the interview. Stage 3. Goals Mutual Goal Setting (“What do you want to happen?”) ▲ Don’t assume you and your client have the same goal ▲ Define explicit goals. ▲ Search for positive assets to help achieve the goal. ▲ Examine the nature of the concern. Stage 4. Restory Working. Exploring Alternatives, Confronting Client Incongruities and Conflict, Restorying (“What are we going to do about it?”) ▲ Open client thought leading to new solutions. ▲ Explore alternatives for action. ▲ Confront client incongruities and conflict. ▲ Restory -- act on new stories. Stage 5. Action Terminating. Generalizing and Acting on New Stories (“Will you do it?”) ▲ Conclude with plan for generalizing interview learning to “real life” and eventual termination of the interview or series of sessions. Stage 5. Action: Strategies for Terminating and Generalizing Homework -- Counselor assigns weekly tasks. Role-playing -- practice new behaviors. Imagery -- imagine future events and behavior. Behavioral charting and journaling -- specific and/or subjective reports of occurrence. Follow-up and support -- periodic checks on behavior maintenance. EXAMPLE INTERVIEW: LISTENING SKILLS TO HELP CLIENTS WITH INTERPERSONAL CONFLICT I Can’t Get Along With My Boss illustrates how listening skills can be used to help the client understand and cope with interpersonal conflict. Interview demonstrates how the five-stage model works in the interview. Reflection questions Was the use of questions effective? How would you increase the rating of some of the empathic response observed in this interview? Was Machiko able to draw a clear contract from Robert? What would you have done differently? EXAMPLE INTERVIEW: LISTENING SKILLS TO HELP CLIENTS WITH INTERPERSONAL CONFLICT--2 I Can’t Get Along With My Boss also demonstrates some of the basics of decisional counseling. Why decisional counseling? Despite its absence in theories of counseling texts, it is likely the most commonly used theory of all. You won’t hear about it much, but it is what helpers do much of the time. All life involve decisions, understanding this system will help you become more competent with other theories of counseling. Decisional methods discussed again in Chapter on logical consequence and integration of skills. What do you think of the above? It can be controversial! Note Taking ▲ If you are relaxed about note taking, it will seldom become an issue in the interview. ▲ Obtain permission early in the session. ▲ Share with your volunteer client the notes or transcripts of the interview. ▲ Obtain his or her feedback. ▲ Avoid note taking if it takes precedence over listening to your client. SUMMARY ▲ The five-stage structure of the microskills interview has been demonstrated in the preceding example. ▲ You can integrate all the microskills and concepts presented into a meaningful, well-formed session. ▲ By acting as a mirror and asking questions, you can encourage many clients to find their own direction. ▲ The decisional style using only listening skills is related to Carl Rogers’s person-centered therapy (Rogers, 1957). Key Points Basic listening sequence ▲ Draw out the client’s story and strengths via questioning, encouraging, paraphrasing, reflection of feeling, and summarization. Sequence is used in multiple settings Key Points Empathy ▲ Seeing the world through the clients’ eyes, hearing them as they have heard and want to be heard, imagining what it would be like to be in their shoes, in the moment. At the same time, maintaining your own self and mixing in “your own things” in understanding the client. ▲ Mirror neurons represent the physical basis of our ability to sense the world of client. But recall that the client also has mirror neurons! Key Points Additive empathy ▲ Clarifying and adding meaning and feelings beyond those originally expressed by the client. ▲ Best assessed by client’s reaction to a statement, not by a simple rating of the interviewer’s comments. Key Points Subtractive empathy ▲ Hearing clients inaccurately and feeding back what you have heard and experienced in a way that is less than what they shared with you. Key Points Positive regard ▲ Selecting positive aspects of client experience and selectively attending to positive aspects of client statements. Key Points Respect and warmth ▲ Respect and warmth are attitudinal dimensions usually shown through nonverbal means—smiling, touching, and a respectful tone of voice—even when differences in values are apparent between interviewer and client. Key Points Concreteness ▲ Being specific rather than vague in interviewing statements constitutes concreteness. Key Points Immediacy ▲ Interviewer statement in the present, past, or future tense. Here-and-now present tense statements tend to be the most powerful. Immediacy is also viewed as the immediate “I–you” talk between interviewer and client. Key Points Nonjudgmental attitude ▲ Suspend your own opinions and attitudes and assume a value neutrality with regard to your clients. Key Points Authenticity and congruence ▲ These are the opposite of incongruity and discrepancy. The interviewer is congruent with the client and is authentic in their relationships. Key Points Five stages of the interview ▲ Stage 1: Relationship: Rapport and structuring (“Hello.”) ▲ Stage 2: Story and Strengths: Gathering information and defining issues (“What’s your concern?” “What are your strengths?”) ▲ Stage 3: Goals: Determining outcomes (“What do you want to happen?”) ▲ Stage 4: Restory: Exploring alternatives and client incongruities (“What are we going to do about it?”) ▲ Stage 5: Action: Generalization and transfer of learning (“Will you do it?”) Key Points Circle of decision making ▲ The five stages of the interview need not always follow the five steps in order. Think of the stages as dimensions that need to be considered in each session. Also, give continuous attention to relationship, positive assets, and wellness at the hub of the circle. COMPETENCY PRACTICE EXERCISE AND SELF-ASSESSMENT Chapter 8 Individual Practice Group practice Self-assessment Individual Practice Exercise 1: Illustrating How the BLS Functions in Different Settings IIC Write counseling leads as they might be used to help a client solve the problem “I don’t have a job for the summer.” Imagine a full statement of issues and write responses that represent the BLS. Open question____________________________________ Closed question__________________________________Encourager_______________________________________ Paraphrase______________________________________ Reflection of feeling _______________________________ Summary________________________________________ Individual Practice Exercise 1: Illustrating How the BLS Functions in Different Settings IIC Now imagine you are talking with a client who has just been told that her or his parents are getting a divorce after more than 25 years of marriage. Your task is to use the BLS to find out how the client is thinking, feeling, and behaving in reaction to this news. Open question____________________________________ Closed question__________________________________ Encourager_______________________________________ Paraphrase______________________________________ Reflection of feeling _______________________________ Summary________________________________________ Individual Practice Exercise 1: Illustrating How the BLS Functions in Different Settings IIC Finally, how would you use these skills in talking with an elementary school student who has come to you crying because no one will play with her or him? Open question____________________________________ Closed question__________________________________ Encourager_______________________________________ Paraphrase______________________________________ Reflection of feeling _______________________________ Summary________________________________________ Individual Practice Exercise 2: The Positive Asset Search and the Basic Listening Sequence (BLS) IIC Imagine that you are role-playing a counseling interview. In a career interview, the client says, “Yes, I am really confused about my future. One side of me wants to continue a major in psychology, while the other—thinking about the future—wants to change to business.” Use the BLS to draw out this client’s positive assets. In some cases, you will have to imagine client responses to your first question. Open question____________________________________ Closed question__________________________________ Encourager_______________________________________ Paraphrase______________________________________ Reflection of feeling _______________________________ Summary________________________________________ Individual Practice Exercise 2: The Positive Asset Search and the Basic Listening Sequence (BLS) IIC Imagine that you are role-playing a counseling interview. You are counseling a couple considering divorce. The husband says, “Somehow the magic seems to be lost. I still care for Chantell, but we argue and argue—even over small things.” Use the positive asset search to bring out strengths and resources on which they may draw to find a positive resolution to their problems. In marriage counseling in particular, many counselors err by failing to note the strengths and positives that originally brought the couple together. Open question____________________________________ Closed question__________________________________ Encourager_______________________________________ Paraphrase______________________________________ Reflection of feeling _______________________________ Summary________________________________________ Individual Practice. Exercise 3: Writing Helping Statements Representing the Five Levels of Empathy IIC Write statements that represent the 5 levels of empathic response to this client’s concern. I’m having trouble here at the community college. I’m the first one in my family who has ever even attempted college. The work doesn’t seem all that hard, but when I turn papers in, my grades seem so low. It’s hard to make friends. I have to work and I don’t have as much money as the other kids seem to. Level 1 (subtractive) Level 2 (slightly subtractive) Level 3 (interchangeable response) Level 4 (slightly additive) Level 5 (additive) Individual Practice. Exercise 3: Writing Helping Statements Representing the Five Levels of Empathy IIC Write statements that represent the 5 levels of empathic response to this client’s concern. Carlena says (near tears), “Alexander and I just broke up. I don’t know what to do. We’ve been living together for almost a year. I don’t have any place to live and I’m so confused.” Level 1 (subtractive) Level 2 (slightly subtractive) Level 3 (interchangeable response) Level 4 (slightly additive) Level 5 (additive) Individual Practice. Exercise 4: Rating Interview Behavior Using Empathic Dimensions IIC Use any systematic group practice exercise from this chapter or the whole book and rate the interviewer’s empathic response. A Practice Interview Using Only Attending and Listening Skills IIC Exercise 5: Practice the BLS. Challenge yourself! Conduct a full interview using only attending behavior and the microskills of the basic listening sequence. Find a volunteer client who is relatively verbal and willing to talk about something of real interest. Negotiate the topic before you start. Let the client know what you plan to do,. After the practice is over, ask client to complete Client Feedback Form (chapter 1) and Practice Interview Feedback Form (this chapter), and to give you immediate feedback on what was helpful and what you might have been missed. Feedback Form IIC Stage 1: Relationship •Describe the nature of the rapport. •Was rapport adequate to move to the next stage? •Did the interviewer provide structuring? Stage 2: Story and Strengths •Define concerns. •Identify assets. •Are only listening skills used? •Was at least one positive client asset identified? Feedback Form IIC Stage 3: Goals •Are only listening skills used? •Was at least one outcome or goal identified? Stage 4: Restory •Are only listening skills used? •Were alternatives generated to address a solution? Feedback Form IIC Stage 5: Action •Generalize. •Were specific plans made for after the session? •Were follow-up plans made? •Terminate CLIENT FEEDBACK FORM IIC (from Ch. 1) In practice sessions, it is very helpful to get immediate feedback. As you practice the microskills, use the Client Feedback Form. FORM IIC Empathy Feedback Form (in this Ch.) In practice sessions, it is very helpful to get immediate feedback. As you practice the microskills, we encourage you to use the feedback forms provided. We provide feedback forms for each specific skill. FORM IIC Practice Interview using only BLS Feedback Form (in this Ch.) In practice sessions, it is very helpful to get immediate feedback. As you practice the microskills, we encourage you to use the feedback forms provided. We provide feedback forms for each specific skill. Those providing feedback… Remember: ▲ Receiver is in charge. ▲ Feedback is for receiver’s development ▲ Focus on what receiver can change. ▲ Check out how feedback was received. Your feedback should be: ▲ Concrete ▲ Specific ▲ Lean ▲ Precise ▲ Non-Judgmental PORTFOLIO OF COMPETENCE What Is Your Level of Mastery of this Skill? IIC Active listening is one of the core competencies of intentional interviewing and counseling. Use the following as a checklist to evaluate your present level of mastery. Check those dimensions that you currently are able to do. Those that remain unchecked can serve as future goals. PORTFOLIO OF COMPETENCE IIC SELF-ASSESSMENT You will find that a lifetime can be spent increasing one’s understanding and competence in the ideas and skills from this chapter. You are asked here to learn and perhaps even master the basic ideas of predictability from skill usage in the session, several empathic concepts, and the five stages of the well-structured interview. We have learned student mastery of these concepts is indeed possible, but for most of us we find that reaching beginning mastery levels makes us aware that we face a lifetime of practice and learning. PORTFOLIO OF COMPETENCE IIC SELF-ASSESSMENT You should feel good that you can conduct an interview using only listening skills. Focus on that accomplishment and use it as a building block toward the future. And, as you do, you are even better prepared for developing your own style and theory. What are your thoughts about conducting an interview using only listening skills? Can you help others using only these skills? SELF-ASSESSMENT Exercise: Self-Evaluation of Integrating Listening Competencies IIC Go to Chapter 8 for a full description of these levels Level 1: Identification and classification. Level 2: Basic competence. Level 3: Intentional competence. Level 4: Psychoeducational teaching competence. SELF-ASSESSMENT Exercise: Self-Evaluation of Integrating Listening Competencies IIC Level 1. Identification and Classification Identify and classify the microskills of listening. Identify and define empathy and its accompanying dimensions. Identify and classify the five stages of the structure of the interview. Discuss, in a preliminary fashion, issues in diversity that occur in relation to these ideas. SELF-ASSESSMENT Exercise: Self-Evaluation of Integrating Listening Competencies IIC Level 2. Basic Competence Use the microskills of listening in a real or role-played interview. Demonstrate the empathic dimensions in a real or roleplayed interview. Demonstrate five dimensions of a well-formed interview in a real or role-played session. SELF-ASSESSMENT Exercise: Self-Evaluation of Integrating Listening Competencies IIC Level 3. Intentional Competence Anticipate predicted results (Ivey Taxonomy) in clients using the listening microskills. Facilitate client comfort, ease, and emotional expression by being empathic. Enable clients to reach the objectives of the five-stage interview process—(a) Relationship; (b) Story and Strengths; (c) Goals: identify; (d) Restory; (e) Action. SELF-ASSESSMENT Exercise: Self-Evaluation of Integrating Listening Competencies IIC Level 4. Psychoeducational Teaching Competence Teach clients the five stages of the interview. Teach small groups this skill. DETERMINING YOUR OWN STYLE AND THEORY: CRITICAL SELF-REFLECTION ON INTEGRATING LISTENING SKILLS CRITICAL SELF-REFLECTION ON INTEGRATING LISTENING SKILLS You are now at the stage to initiate construction of the your own interviewing process. You likely have found some skills work better for you than. We encourage you to look back on these first eight chapters as you consider the following basic question leading toward your own style and theory. What single idea stood out for you among all those presented in this text in class, or through informal learning? Write your ideas in your journal.